Should more people with heart failure be on digoxin?

18th February 2016

More research is needed to see if a drop in use of the drug digoxin in treating people with heart failure is appropriate or whether it is depriving them of an important medication, say researchers.

In America in 2005, a third of patients with heart failure and reduced ejection fraction (the amount of blood being pumped out of the heart at each beat) were on digoxin but by 2014 it was just one in ten. In those with heart failure and a preserved ejection fraction, 16 per cent were on the drug in 2005 and just over one in 20 in 2014.

Digoxin is derived from digitalis, a potentially poisonous compound found in foxgloves, and can help make the heart beat stronger and with a more regular rhythm. 

It was widely used in treating heart failure before beta-blockers. and the older drug has been questioned in some more recent studies.

The researchers, led by Dr Nish Patel from the University of Miami Miller School of Medicine in Florida, said that trials were needed see if there was a benefit to adding digoxin to contemporary guidelines-based treatments.

They might also show whether the drop-off in use "is appropriate and enhancing patient safety or whether it may be depriving patients of an important medication to reduce hospital admissions for heart failure and improve quality of life."

The researchers looked at the prescriptions for 250,000 patients. They said that use of the drug throughout the decade was significantly associated with the use of an internal defibrillator (ICD) or pacemaker, a lower ejection fraction, the heart rhythm problem atrial fibrillation, diabetes and normal kidney function.

Digoxin was less likely to be prescribed to people who were older, smoked, or had kidney problems, high blood pressure, coronary heart disease or anaemia.

The report has just been published in the Journal of the American College of Cardiology: Heart Failure.

For more details see here.